|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 3 | Page : 355-357
An exploration of pulmonary fitness of construction workers in Delhi NCR in light of the building and other construction workers act, 1996
S Krishnakumar1, Shailaja S Thakur2, Jesim Pais3, Nandita Narayanasamy4
1 Associate Professor, Sri Venkateswara College, University of Delhi, New Delhi, India
2 Assistant Professor, Department of Economics, Sri Venkateswara College, University of Delhi, New Delhi, India
3 Director, Society for Social and Economic Research, Sri Venkateswara College, University of Delhi, New Delhi, India
4 Associate Professor, Department of Biochemistry, Sri Venkateswara College, University of Delhi, New Delhi, India
|Date of Submission||23-Nov-2021|
|Date of Decision||10-May-2022|
|Date of Acceptance||29-Jul-2022|
|Date of Web Publication||22-Sep-2022|
Department of Biochemistry, Sri Venkateswara College, University of Delhi, Benito Juarez Road, Dhaula Kuan, New Delhi - 110 021
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Workers in the construction sector are exposed to high concentrations of particulate matter at their workplace. This increases their susceptibility to various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The study reports comparative pulmonary fitness and hematological parameters of the migrant workers in the construction sector versus other sectors in Delhi. Parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the ratio of FEV1 to FVC, and peak expiratory flow were measured in both groups using a spirometer. We observed significant differences (P < 0.05) in FEV1 and FVC between both groups. The study thus confirms that workers exposed to poor air quality at the construction site are susceptible to respiratory diseases, particularly ARDS. All of this reflects the poor enforcement of the adequate safety measures well enlisted in social legislations such as the Building and Other Construction Workers Act.
Keywords: Acute respiratory distress syndrome, Building and Other Construction Workers Act, the ratio of forced expiratory volume in 1s to forced vital capacity, migrant construction labor
|How to cite this article:|
Krishnakumar S, Thakur SS, Pais J, Narayanasamy N. An exploration of pulmonary fitness of construction workers in Delhi NCR in light of the building and other construction workers act, 1996. Indian J Public Health 2022;66:355-7
|How to cite this URL:|
Krishnakumar S, Thakur SS, Pais J, Narayanasamy N. An exploration of pulmonary fitness of construction workers in Delhi NCR in light of the building and other construction workers act, 1996. Indian J Public Health [serial online] 2022 [cited 2022 Sep 28];66:355-7. Available from: https://www.ijph.in/text.asp?2022/66/3/355/356600
The data on employment from the national sample surveys in recent years show that the construction sector accounting for the third highest share in total employment in India is marginally higher than the manufacturing sector. As per the estimates of the Periodic Labour Force Survey of 2017–2018, of the total employment of 471.3 million, 380.7 million (i.e., 80.8%) work is in the unorganized sector.
At construction sites, the occupational exposure limits of air pollutants frequently exceed norms. Fine dust particles of cement, sand, silica, and asbestos initially cause mucus hypersecretion and lung irritation and trigger an inflammatory reaction. This can lead to defective oxygen diffusion and impaired lung function, consequently leading to chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome (ARDS). It is estimated that 42% of COPD and a gradual loss-of-lung function are attributed to such occupational exposures. Studies in different parts of India too have found poor respiratory health in construction workers.
Occupational safety regulations are aimed at protecting workers against occupational hazards. However, an important lacuna in the Indian labor regulatory regimen is that not all workers are covered by these regulations. A large part of the informal sector with small enterprises is beyond the labor regulatory framework. The Building and Other Construction Workers Act (BOCWA), 1996 is specifically designed and aimed at protecting workers in the construction sector who are largely migrants from across the country by providing them with protective devices including gloves and respiratory masks.
According to the World Health Organization, nearly one-third of the world disease burden may be attributed to environmental risk factors, with an incidence of lower respiratory infection being the second largest. Considering the proportion of construction labor force in India, their contribution to this larger disease burden cannot be ignored.
This study was undertaken to ascertain a comparative analysis of the pulmonary fitness of the workers in the construction sector in comparison to their counterparts in other sectors. In urban areas like Delhi, the construction workers are part of the larger migrant workforce who suffer from poor nutrition, particularly with respect to the consumption of micronutrients.
The study is based on a sample of participant respondents from Delhi. The test samples (n = 30) were drawn from three locations, namely Rangpuri Pahadi, Bhavar Singh Camp, and Kidwai Nagar Construction site. In each of these sites, a geographic cluster random sampling was done among migrant construction workers with at least 3 years of work experience and aged between 20 and 60 years, most of whom were registered with the BOCWA. Workers having a history of respiratory symptoms or any known lung disease such as asthma, bronchitis, and tuberculosis were excluded from the study. The control group consists of a sample of purposively selected age-matched normal healthy migrant workers employed in other sectors (n = 16).
Parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the ratio of FEV1 to FVC (FEV1/FVC), peak expiratory flow rate (PEFR), and forced expiratory flow (FEF 25%–75%) were assessed using UNI-EM Spiromin 15.0.5 (Universal medical instruments, Goregaon, Mumbai, Maharastra, India). Spirometry was conducted on respondents who cleared the initial screening through a questionnaire and agreed to written consent. Tests were performed in a seated position and were repeated three times with adequate rest between each test. The software allows the calculation of the predicted values based on age, sex, weight, and height of the respondents, and three basic patterns: normal, COPD, and ARDS, were estimated as per the standards.
The height and weight of each participant worker were measured, and
of the respondents was calculated. The mid-arm circumference (measured using standard tape) and triceps skinfold measurements (using a skinfold caliper) were used to calculate the percentage of body fat (% body fat) and mid arm muscle area (MAMA) using the Heymsfield equation.
One milliliter of blood was centrifuged at 5000 rpm for 10 min, and the hematocrit value was obtained. 5 μl of blood was mixed with 995 μl of red blood cell (RBC)-diluting fluid and RBCs were counted using a hemocytometer. RBC count =.
Hemoglobin was estimated using the Drabkins' method. Hematological indices were calculated:
Mean corpuscular volume (MCV) = Hematocrit (%) × 10/RBC count (fL)
Mean corpuscular hemoglobin (MCH) = Hb (g/L) × 10/RBC count (pg).
Independent t-test was used to compare the lung function parameters between the exposed and nonexposed group, with the level of statistical significance set at P < 0.05 for all comparisons. Unpaired t-test was used for group-wise comparisons.
The mean age of the construction workers (test group) and control group was 37.7 and 33.5 years, respectively. Mean weight and height of the construction workers were 57.97 kg and 163.37 cm, respectively, while for the control group, they were 55.75 kg and 167.77 cm, respectively. The independent t-test done to compare between exposed group and nonexposed group of workers show that there was no statistically significant difference of age, weight, and height, with P > 0.05. The mean for the smoking status of migrant construction labor (6/30) was similar to the nonconstruction control group (3/16). Other anthropometric data such as BMI, % body fat, and MAMA also did not show any significant difference between the test and control groups. In other words, statistical comparisons of the matching variables (age, height, weight, BMI, and % body fat) show inherently similar values for both groups. The anthropometric data in this study show that both groups have similar metabolic status and are not subject to food, calorie, or protein deprivation.
Prolonged exposure to construction-related air pollutants in the test group of migrant construction workers showed a significant reduction in percent predicted values and mean values of FVC, FEV1, PEFR, and FEF 25%–75%, when compared with their matched controls (P < 0.01) [Table 1]. However, these workers did not show a statistically significant reduction in FEV1/FVC relative to controls even though the actual values of FEV1 and FVC were lower. When interpreted according to the American Thoracic Society guidelines, the impairment in lung function recorded in migrant construction site workers can be described more as ARDS, with a lower incidence of COPD.
|Table 1: Lung function data in migrant construction workers with exposure to pollutants (n=30) compared to the control groups (n=16)|
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It is important to note here that many studies have reported a higher incidence of COPD in construction workers. However, similar to our observations, Nabilah et al (2020) have reported a significant and similar decrease in both FVC and FEV1, leading to no significant change in FEV1 /FVC. The higher incidence of ARDS is serious because it can lead to chronic hypoxic conditions.
When compared to accepted reference values, all workers showed low hemoglobin values and the hematological indices show that they suffered from hypochromic normocytic anemia [Table 2]. Erythrocytosis and macrocytosis both are shown to be triggered by hypoxemia, particularly in patients with respiratory dysfunctions such as ARDS. In the current study, although the MCV levels do not indicate macrocytosis, the total RBC count is on the higher side of the reference range. Hypoxia caused by impaired pulmonary function coupled with a possible iron deficiency due to poor nutrition could however account for the hypochromic but normocytic anemia.
The construction workers in Delhi show poor pulmonary fitness with 60% showing moderate obstruction, 20% showing severe obstruction, and greater than 90% showing decrease in FVC and FEV1 indicating a high incidence of ARDS, compared to the control group.
Although the anthropometric data of the construction workers do not indicate calorie or protein deficiency, the hematological parameters indicate micronutrient deficiencies that could contribute to hypoxemia, which could further add to pulmonary dysfunction.
Our study shows that despite registration under the BOCWA, regulations have been ineffective in protecting the health of workers in the construction sector in Delhi. The BOCWA Welfare Boards in coordination with civil society groups and trade unions should conscientize and enforce the employers to assure that the workers are provided with protective equipment and assured of safety measures at the workplace.
This coupled with early detection of pulmonary dysfunctions among workers through employee state insurance hospitals would secure the Indian construction labor force and would go a long way in reducing our contribution to the global disease burden. Although there have been a number of studies that highlight the plight of the construction workers in the light of the BOCWA, ours is possibly the first study of its kind which draws attention to the same in light of the biochemical and physiological parameters.
The authors acknowledge the support of Arshiya Dewan, Mansi Goyal, Vitasta Tiku, Shashidhar Sharma, Tushar Bhatia, Ekanta Kaur Nagi, Krishna Prasad, Krittika Chaddha, Kriti Bhatia, and Varsha Tayal, as well as undergraduate students of Sri Venkateswara College who helped in the conduct of the survey. This is the revised version of the paper adjudicated best at the International Conference titled “Securing the future: ENCON 2017” on January 4–6, 2017, held at New Delhi.
Financial support and sponsorship
This research study benefited from the funding of INR 4,00,000, provided by the Delhi University Innovation Projects SVC-315.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]